Molly (91): DoLS example from practice

Molly (91) was admitted to a large general hospital from her home with a chest infection. She had advanced dementia, and her daughter Jean had given up her work as a hospital nurse to care for her, with the help of two other nurses funded by a direct payment. The family belonged to a minority religious group, and often felt misunderstood by the wider community. 

Molly lacked capacity to consent to admission, or to treatment: her admission, and the treatment for her chest infection, were agreed to be in her best interests. Molly also had a pressure sore and an infected toe. Jean and the other nurses had been treating these under the supervision of the GP, who agreed that Molly was probably approaching the end of her life. 

Relations between ward staff and Jean were poor. Jean was seen as bossy and interfering, and in her turn she felt staff ignored her greater knowledge of her mother’s condition. She also complained about staff being slow to provide essential personal care. Voices were raised on both sides. Staff then criticised Jean’s previous care of her mother, citing the pressure sore, and raised a safeguarding alert. They allowed other relatives, and religious leaders, to visit Molly, but barred Jean from the ward. Jean’s solicitor queried this and the hospital then gave itself an urgent DoLS authorisation, and requested a standard authorisation.

The best interests assessor, Frank, spoke to the other nurses who had looked after Molly at home, and to the GP. They praised Jean’s nursing skills and commitment to her mother’s wellbeing, while commenting on her perfectionism and tendency to micro-manage. Molly’s elderly husband, and other relatives and friends, all wanted Molly home as soon as she was well enough, to be cared for by Jean, the other nurses and the GP, for the rest of her life. The hospital’s position was that Molly should remain there, so her other medical problems could be treated. Staff said that if the deprivation of liberty was not authorised they would still prevent Jean from seeing her mother, under the umbrella of safeguarding. Frank explained that where relatives and professionals disagreed, if mediation was unsuccessful the hospital must apply to the Court of Protection for a best interests decision. He shared his opinion that it was disproportionate to the risk and seriousness of harm to Molly to refuse to allow Jean to visit, and to refuse to consider whether, and how, Molly might return home.

After discussions with the hospital’s legal department, and with the GP, it was decided that Molly’s treatment could safely continue in her own home, with additional input from the district nurses.

Read more: Best interests assessment (standard form 3)